Advertisement

Medical Student Suicide: An Assessment of Risk Factors and Prevention Strategies

  • Carol Swetlik
  • Kathleen N. Franco
Chapter

Abstract

Throughout their careers, medical caregivers face high levels of stress and are at increased risk of depression, burnout, and suicide. Even early in medical training, medical students have been shown to have increased prevalence of mental health concerns and mental distress. Rates of suicide completion in medical students have been in decline since the 1950s. However, as detailed by David Muller and other colleagues, lives continue to be tragically lost to suicide, leaving a resounding impact on families and students, schools, and the medical community. The prevalence of risk factors associated with suicide, including depression, anxiety, burnout, and substance abuse, remains high. Interventions can be made to reduce the burden of mental distress. Familial support and marital status may serve as protective factors against the development or exacerbation of psychopathology in this population. Additionally, the majority of medical schools have begun to implement a wide variety of curricular wellness programs and suicide risk-reduction strategies to ensure identification and treatment of at-risk students, as well as continued wellness for others.

Keywords

Burnout Stress Substance abuse Depression Anxiety Prevention Suicide 

References

  1. 1.
    Schernhammer E. Taking their own lives: the high rate of physician suicide. N Engl J Med. 2005;352(24):2473–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Simon HJ. Mortality among medical students, 1947–1967. J Med Educ. 1968;43(11):1175–82.PubMedGoogle Scholar
  3. 3.
    Hays LR, Cheever T, Patel P. Medical student suicide, 1989–1994. Am J Psychiatry. 1996;153(4):553–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Cheng J, Kumar S, Nelson E, Harris T, Coverdale J. A national survey of medical student suicides. Acad Psychiatry. 2014;38(5):542–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Hawton K. Suicide in doctors while under fitness to practise investigation. BMJ. 2015;350:h813.CrossRefPubMedGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention, National Center for Health Statistics: underlying cause of death 1999–2015 on CDC WONDER online database. 2017. http://wonder.cdc.gov/ucd-icd10.html. Accessed 3 Mar 2017.
  7. 7.
    Baca-Garcia E, Perez-Rodriguez MM, Oquendo MA, Keyes KM, Hasin DS, Grant BF, et al. Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior. J Affect Disord. 2011;134(1):327–32.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343–52.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39(6):594–604.CrossRefPubMedGoogle Scholar
  10. 10.
    Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260(17):2521–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84(2):236–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Carson AJ, Dias S, Johnston A, McLoughlin MA, O’connor M, Robinson BL, et al. Mental health in medical students: a case control study using the 60 item General Health Questionnaire. Scott Med J. 2000;45(4):115–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–84.CrossRefPubMedGoogle Scholar
  16. 16.
    Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med. 1997;72(6):542–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Saravanan C, Wilks R. Medical students’ experience of and reaction to stress: the role of depression and anxiety. Sci World J. 2014.  https://doi.org/10.1155/2014/737382.
  18. 18.
    Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Educ. 2001;35(1):12–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Inam SB. Anxiety and depression among students of a medical college in Saudi Arabia. Int J Health Sci (Qassim). 2007;1(2):295–300.Google Scholar
  20. 20.
    Stewart SM, Betson C, Marshall I, Wong CM, Lee PW, Lam TH. Stress and vulnerability in medical students. Med Educ. 1995;29(2):119–27.CrossRefPubMedGoogle Scholar
  21. 21.
    Bassols AM, Okabayashi LS, Silva AB, Carneiro BB, Feijó F, Guimarães GC, et al. First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms? Rev Bras Psiquiatr. 2014;36(3):233–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry. 1984;25(6):552–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. J Affect Disord. 2001;64(1):69–79.CrossRefPubMedGoogle Scholar
  24. 24.
    Noyes R. Suicide and panic disorder: a review. J Affect Disord. 1991;22(i):1–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Schmidt N, Woolaway-Bickel K, Bates M. Evaluating panic specific factors in the relationship between suicide and panic disorders. Behav Res Ther. 2001;39(6):635–49.CrossRefPubMedGoogle Scholar
  26. 26.
    O’Rourke SR, Bray AC, Anastopoulos AD. Anxiety symptoms and disorders in college students with ADHD. J Atten Disord. 2017.  https://doi.org/10.1177/1087054716685837.
  27. 27.
    Tuttle J, Schuerich N, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry. 2010;34(3):220–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Mazzone L, Ducci F, Scoto MC, Passaniti E, D’arrigo VG, Vitiello B. The role of anxiety symptoms in school performance in a community sample of children and adolescents. BMC Public Health. 2007;7(1):347.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Esch P, Bocquet V, Pull C, Couffignal S, Lehnert T, Graas M, et al. The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving. BMC Psychiatry. 2014;14(1):237.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Blair-West GW, Cantor CH, Mellsop GW, Eyeson-annan ML. Lifetime suicide risk in major depression: sex and age determinants. J Affect Disord. 1999;55(2–3):171–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Pepitone-Arreola-Rockwell F, Rockwell D, Core N. Fifty-two medical student suicides. Am J Psychiatry. 1981;138(2):198–201.CrossRefPubMedGoogle Scholar
  32. 32.
    Vitaliano PP, Maiuro RD, Russo J, Mitchell ES. Medical student distress: a longitudinal study. J Nerv Ment Dis. 1989;177(2):70–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Richman JA, Flaherty JA. Gender differences in medical student distress: contributions of prior socialization and current role-related stress. Soc Sci Med. 1990;30(7):777–87.CrossRefPubMedGoogle Scholar
  34. 34.
    Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73.CrossRefPubMedGoogle Scholar
  35. 35.
    Lloyd C, Gartrell NK. Sex differences in medical student mental health. Am J Psychiatry. 1981;138(10):1346–51.CrossRefPubMedGoogle Scholar
  36. 36.
    Jeon HJ, Roh MS, Kim KH, Lee JR, Lee D, Yoon SC, et al. Early trauma and lifetime suicidal behavior in a nationwide sample of Korean medical students. J Affect Disord. 2009;119(1):210–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Phelan SM, Dovidio JF, et al. Mental well-being in first year medical students: a comparison by race and gender. J Racial Ethn Health Disparities. 2015;2(3):403–13.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Fan AP, Kosik RO, Mandell GA, Tran DT, Cheng HM, Chen CH, et al. Suicidal ideation in medical students: who is at risk? Ann Acad Med Singap. 2012;41(9):377–82.PubMedGoogle Scholar
  39. 39.
    Haglund ME, aan het Rot M, Cooper NS, Nestadt PS, Muller D, Southwick SM, et al. Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student well-being. Acad Med. 2009;84(2):258–68.CrossRefPubMedGoogle Scholar
  40. 40.
    Meehan PJ, Lamb JA, Saltzman LE, O’carroll PW. Attempted suicide among young adults: progress toward a meaningful estimate of prevalence. Am J Psychiatry. 1992;149(1):41–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Pyskoty CE, Richman JA, Flaherty JA. Psychosocial assets and mental health of minority medical students. Acad Med. 1990;65(9):581–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA, et al. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc. 2006;81(11):1435–42.CrossRefPubMedGoogle Scholar
  43. 43.
    Katz J, Monnier J, Libet J, Shaw D, Beach SR. Individual and crossover effects of stress on adjustment in medical student marriages. J Marital Fam Ther. 2000;26(3):341–51.CrossRefPubMedGoogle Scholar
  44. 44.
    Coombs RH, Fawzy FI. The effect of marital status on stress in medical school. Am J Psychiatry. 1982;139(11):1490–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.CrossRefPubMedGoogle Scholar
  46. 46.
    Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance use among senior medical students: a survey of 23 medical schools. JAMA. 1991;265(16):2074–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN. Burnout and alcohol abuse/dependence among U.S. medical students. Acad Med. 2016;91(9):1251–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Wasserman JA, Fitzgerald JE, Sunny MA, Cole M, Suminski RR, Dougherty JJ. Nonmedical use of stimulants among medical students. J Am Osteopath Assoc. 2014;114(8):643–53.CrossRefPubMedGoogle Scholar
  49. 49.
    Conard S, Hughes P, Baldwin DC, Achenbach KE, Sheehan DV. Substance use by fourth-year students at 13 U.S. medical schools. J Med Educ. 1988;63(10):747–58.PubMedGoogle Scholar
  50. 50.
    Bucher JT, Vu DM, Hojat M. Psychostimulant drug abuse and personality factors in medical students. Med Teach. 2013;35(1):53–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study. BMJ. 2008;337:a2155.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Shoukat S, Anis M, Kella DK, Qazi F, Samad F, Mir F, et al. Prevalence of mistreatment or belittlement among medical students: a cross sectional survey at a private medical school in Karachi, Pakistan. PLoS One. 2010;5(10):e13429.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance use among physicians and medical students. Med Student Res J. 2014;3:26–35.Google Scholar
  54. 54.
    Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. A systematic review of stress-management programs for medical students. Acad Psychiatry. 2013;37(3):158–64.CrossRefPubMedGoogle Scholar
  55. 55.
    Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010;85(10):1635–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Kiessling C, Schubert B, Scheffner D, Burger W. First year medical students’ perceptions of stress and support: a comparison between reformed and traditional track curricula. Med Educ. 2004;38(5):504–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Drolet BC, Rodgers S. A comprehensive medical student wellness program: design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103–10.CrossRefPubMedGoogle Scholar
  58. 58.
    Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87(3):320–6.CrossRefPubMedGoogle Scholar
  59. 59.
    Downs N, Feng W, Kirby B, McGuire T, Moutier C, Norcross W, et al. Listening to depression and suicide risk in medical students: the Healer Education Assessment and Referral (HEAR) Program. Acad Psychiatry. 2014;38(5):547–53.CrossRefPubMedGoogle Scholar
  60. 60.
    Rohe DE, Barrier PA, Clark MM, Cook DA, Vickers KS, Decker PA. The benefits of pass-fail grading on stress, mood, and group cohesion in medical students. Mayo Clin Proc. 2006;81(11):1443–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Bloodgood RA, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84(5):655–62.CrossRefPubMedGoogle Scholar
  62. 62.
    Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med. 2011;86(1):116–21.CrossRefPubMedGoogle Scholar
  63. 63.
    Hassed C, De lisle S, Sullivan G, Pier C. Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract. 2009;14(3):387–98.CrossRefPubMedGoogle Scholar
  64. 64.
    Erogul M, Singer G, Mcintyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26(4):350–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44–53.CrossRefPubMedGoogle Scholar
  66. 66.
    Austenfeld JL, Paolo AM, Stanton AL. Effects of writing about emotions versus goals on psychological and physical health among third-year medical students. J Pers. 2006;74(1):267–86.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  2. 2.Department of Psychiatry and PsychologyCleveland ClinicClevelandUSA

Personalised recommendations